What Is Atopic Dermatitis? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Atopic dermatitis (AD), the most common form of eczema, is a chronic (long-lasting) skin condition linked to an impaired skin barrier and underlying immune-system problems within the skin.

Here’s everything you need to know about the skin condition, from its hallmark symptoms and prevalence to treatment and diagnosis.

What Is Atopic Dermatitis?

Atopic dermatitis is a chronic condition that causes itchy rashes and dry, discolored skin.

Atopic dermatitis can begin in infancy and is most common in children and adolescents, but it affects adults as well, says Amy McMichael, MD, a dermatologist at Atrium Health Wake Forest Baptist in Winston Salem, North Carolina. About 9.6 million U.S. children and 16.5 million U.S. adults have atopic dermatitis.

People with atopic dermatitis often have other chronic conditions, too. “Atopic dermatitis can be associated with asthma and environmental and food allergies,” says Dr. McMichael.

While uncomfortable, it isn’t contagious. Although there’s no cure, there are many treatment options that can help manage the condition.

Signs and Symptoms of Atopic Dermatitis

All types of eczema, including atopic dermatitis, are inflammatory, meaning the affected skin is inflamed, dry, and itchy. “One way we describe atopic dermatitis is, ‘It’s an itch that rashes,’” says Joy Wan, MD, a dermatologist and assistant professor of dermatology at Johns Hopkins University School of Medicine in Baltimore.

Atopic dermatitis often involves the following symptoms:

  • Itchiness (also called pruritus)
  • Dry and cracked skin
  • Raw and sensitive skin due to scratching
  • Rash or patches of discolored skin
  • Scaly patches
  • Thickened skin
  • Oozing and crusting
  • Darkened skin surrounding the eyes
Atopic dermatitis in white people typically looks pink or red, while in people of color, rashes may appear dark brown, purple, or ashen gray, says Shilpi Khetarpal, MD, a dermatologist at Cleveland Clinic in Ohio. People of color may experience small, raised bumps on the skin.

?Other atopic dermatitis symptoms are the same, regardless of race or ethnicity.
Illustrative graphic titled Atopic Dermatitis in Lighter vs Darker Skin Tones. In white skin, AD is usually red or pink. In skin of color, AD can appear dark brown, purple or ashen gray. Everyday Health logo
Certain symptoms of atopic dermatitis vary by skin tone.

In adults with AD, the rash most often appears on the hands, neck, in the bend of the elbows and knees, the skin around the eyes, and the ankles and feet, says Dr. Wan.

In infants, atopic dermatitis most often affects the face, scalp, and areas of skin where the joint bends. In older children, AD is most likely to show up in the bends of the elbows and knees, the neck, and the ankles.

People with atopic dermatitis will typically experience periods where the disease is worse, called flares, followed by periods where the skin improves, called remissions.

Causes and Risk Factors of Atopic Dermatitis

As mentioned, atopic dermatitis is not contagious. It’s related to a combination of factors: genetic, immune-related, and environmental.

Genetics are a major influence. “People who have atopic dermatitis generally have a genetic predisposition toward it. That’s been supported by a lot of studies that have found shared immunologic or skin barrier impairment on a genetic level for a lot of patients,” says Wan.

This impairment is related to a deficiency of a protein called filaggrin. Without normal levels of this protein, the skin barrier changes and loses moisture, making the skin dry and more prone to damage and inflammation.

Researchers believe that this inflammation triggers the itch-scratch cycle, leading to further skin damage as well as increased risk for bacterial infection.

For some people, atopic dermatitis is related to having too much of the bacteria Staphylococcus aureus on the skin, which displaces helpful bacteria and weakens the skin barrier.

Although atopic dermatitis is not an autoimmune disease (a condition in which your immune system attacks your body), the immune system in someone with AD can malfunction and be overactive. This can create inflammation in the skin and contribute to atopic dermatitis.

As for environmental causes, living in an area with a harsh climate raises the risk of developing atopic dermatitis, although there’s not as much evidence to show that environmental factors alone will cause AD, says Wan.

“Emotional stress may worsen the condition but does not cause it,” says McMichael.

How Is Atopic Dermatitis Diagnosed?

Atopic dermatitis is usually a clinical diagnosis, meaning a healthcare provider diagnoses it by evaluating the patient’s symptoms and medical history.

?A provider will ask about itch, look for the presence and location of skin lesions, and ask about a personal or family history of allergies.

In some situations, atypical symptoms might make a physician uncertain about an atopic dermatitis diagnosis. In those cases the physician might request a skin biopsy to clarify or confirm a diagnosis, says Wan.

A skin biopsy is a minor procedure that involves using a scalpel, sharp blade, or punch instrument to remove a very small section of the rash (after numbing the area with a local anesthetic). The physician sends the sample to a lab to be examined under a microscope to determine what is causing the rash.

Many doctors aren’t adequately trained to recognize atopic dermatitis in skin of color, leading to delayed diagnosis or misdiagnosis. “Many people think of eczema as being red, dry, and itchy, which is how it appears in people with lighter skin. However, in darker skin types the redness may be difficult to see because the eczema tends to look darker brown, purple, or ashen gray in color,” says Dr. Khetarpal.

Common scales used to diagnose atopic dermatitis that include rating how red the patches are can underestimate the severity of AD in people with darker skin, according to research.

Treatment for Atopic Dermatitis

After you’ve been diagnosed with atopic dermatitis, your dermatologist may recommend various treatments, ranging from medication to light therapy, along with certain lifestyle changes that could help stave off flare-ups. These are some of the most common options to treat atopic dermatitis.

Atopic Dermatitis Medication

You may need over-the-counter or prescription medications for atopic dermatitis, depending on the severity of your symptoms. Here’s what to know about each one:

Corticosteroids?Also known as topical steroids, corticosteroids can take the form of ointment, cream, lotion, or spray.

?These medications can reduce inflammation and allow the skin to heal. They’re often used for mild AD, says Wan.

“This is probably the most common topical treatment and can be used in adults and children,” says Wan.

Topical steroids are classified by strength, ranging from “super potent” to “least potent.”

Nonsteroid-Based Topical Treatments Dermatologists may prescribe nonsteroid-based topicals instead of corticosteroids for long-term use or for cases involving sensitive areas like the face or genitals, says Wan. They’re often used for mild AD. This group of medications includes:

  • Topical PDE4 Inhibitors These medications block phosphodiesterase 4 (PDE-4), an enzyme involved in AD inflammation.

    ?Crisaborole (Eucrisa) ointment is approved to treat atopic dermatitis in children ages 3 months and older and adults.
  • Topical Calcineurin Inhibitors (TCIs) TCIs reduce inflammation by preventing the immune system from activating certain cells.

    ?Medications include tacrolimus ointment (sold as a generic and under the brand name Protopic) and pimecrolimus cream (sold as a generic and under the brand name Elidel). Both can be used in people ages 2 and up.
  • Topical JAK Inhibitor This type of medication works by blocking enzymes that contribute to inflammation and itch and affect skin barrier function.

    There’s currently one medication in this class: ruxolitinib (Opzelura). The U.S. Food and Drug Administration (FDA) requires that ruxolitinib carry a warning because of the small risk of potentially serious side effects.

Antihistamines Over-the-counter oral antihistamines can help with itch, says McMichael.

Antibiotics A doctor may prescribe antibiotics if your atopic dermatitis becomes infected.

Systemic Treatments These therapies are taken by mouth (oral) or as an injection that treat the inflammation of the atopic dermatitis systemically from the inside out, says Wan. Physicians will usually reserve these treatments for people with more severe AD. This group includes:

  • Biologics These injectable medications specifically target molecules in the body that are responsible for triggering inflammation.

    ?Dupilumab (Dupixent) is approved for atopic dermatitis in people ages 6 months and older, and tralokinumab-Irdm (Adbry) is approved for adolescents and adults. Doctors can prescribe other biologics off-label (meaning they may work to control the inflammation, but they aren’t specifically approved for AD).
  • Immune Modulators The oral JAK inhibitors abrocitinib (Cibinqo)?and upadacitinib (Rinvoq) belong to this category and are approved for people who aren’t getting adequate symptom relief from biologics. Cibinqo is approved for adults, and Rinvoq is approved for people ages 12 and older. Both medications carry an FDA warning because of the small risk of potentially serious side effects.
  • Oral Immunosuppressants These medications can help suppress an overactive immune system to reduce inflammation and lessen AD symptoms.

Other immunosuppressive drugs are sometimes used to treat atopic dermatitis but are not specifically approved for AD:

Phototherapy Also known as light therapy, dermatologists often reserve medically regulated phototherapy for more widespread or severe atopic dermatitis, says Wan. The most common type of phototherapy used to treat AD is narrowband ultraviolet B (NB-UVB) light, although your dermatologist may recommend other types.

Generally speaking, with appropriate treatment it’s reasonable to expect a flare-up to subside within a couple of weeks, says Wan.

“The symptoms of a flare can go away in as little as a few days, especially if you start active treatment very quickly. But a flare can also extend for weeks or even months if you’re not treating or undertreating it,” she says.

In addition to taking atopic dermatitis medications as directed, doing something as simple as using a daily moisturizer can help reduce the amount of time that a flare will last, Wan says.

Home Remedies for Atopic Dermatitis

Along with medical treatment, your dermatologist may recommend certain self-care strategies and home remedies to manage atopic dermatitis, which could help lessen the severity of symptoms or keep flare-ups at bay. They include:

  • Bleach Baths A diluted bleach bath can help with AD flares, especially when the skin is infected, says Wan.
  • Oatmeal Adding colloidal oatmeal to your bath or moisturizing your skin with colloidal oatmeal can help relieve itch.

  • Wet Wrap Therapy This therapy involves applying moisturizer and medication to a flare-up, then wrapping the affected area with warm, damp fabric or gauze and then a second layer of dry cloth. Wet wrap therapy helps topic treatments work a bit more effectively, says Wan. The therapy can help rehydrate and calm the skin, too.

Complications of Atopic Dermatitis

Complications of atopic dermatitis can include one or more of the following conditions:

  • Asthma and Hay Fever It’s common for people with atopic dermatitis to develop asthma and hay fever (seasonal allergies).
  • Food Allergies People with AD often have food allergies, and one of the main symptoms of this condition is hives
  • Chronic Itchy, Scaly Skin A skin condition called neurodermatitis (lichen simplex chronicus) starts with a patch of itchy skin. Scratching the area can make it feel better at first but can lead to more long-term itchiness. This condition can cause the affected skin to become discolored, thick, and leathery.
  • Patches of Skin That Are Darker or Lighter Than the Surrounding Area After the initial rash heals, some patches of skin may remain a different color for months, a condition called post-inflammatory hyperpigmentation or hypopigmentation. Skin discoloration in AD is more likely in people of color, but it can happen to anyone with the condition.

  • Skin Infections Repeated scratching that breaks the skin can cause open sores and cracks which can become infected. If untreated, these skin infections can spread and become life-threatening.
  • Sleep Problems The itchiness of atopic dermatitis can interfere with sleep.
  • Mental Health Conditions People with atopic dermatitis are more likely to have depression or anxiety.

Your Atopic Dermatitis Care Team

Different specialists can help you manage the potential complications of atopic dermatitis. Along with a dermatologist, other members of your atopic dermatitis care team may include:

  • Allergist An allergist is a doctor who treats allergies, asthma, and immune disorders. They can help manage inflammatory skin conditions like atopic dermatitis, which are commonly linked to food allergies and seasonal allergies.
  • Psychodermatologist or Another Mental Health Professional As mentioned, people with atopic dermatitis are prone to depression, anxiety, and other mental health concerns. A psychodermatologist is an expert on the interaction between the skin and mental health and can help you cope with the emotional toll of atopic dermatitis. If you can’t find a psychodermatologist, other providers like psychiatrists, psychologists, or licensed therapists can also help.

Tips for Preventing Atopic Dermatitis

There are a number of strategies that can help prevent AD flare-ups:

Moisturize

Something as simple as using an effective and unscented moisturizer twice a day can help prevent or improve atopic dermatitis flares, says Wan.

Shower Daily

Take a daily bath or shower, but avoid hot water, which can dry out skin. Shorter is better — limit time in the bath or shower to 10 minutes or less. Pat skin dry rather than toweling off vigorously.

Avoid Known Triggers

These can include materials that can be abrasive to the skin, such as wool; heat and sweat; cold and dry air; fragrances; harsh cleaning products and detergents; allergens like pollen, dust mites, and pet dander; and stress.

Infants and children may have flares triggered by certain foods, such as eggs and dairy. But in adults there is very limited evidence to strongly support that any one diet will help prevent AD or flares, says Wan.

Limit Stress and Get Adequate Sleep

There is a connection between atopic dermatitis and sleep problems, but researchers are still trying to understand it. “We know that people with eczema [or] atopic dermatitis have sleep issues, which include short sleep cycles sometimes and dysregulated sleep. It’s hard to know if AD is causing the sleep issues or if sleep issues (in part) are one of the factors that cause or worsen AD — or both,” says Wan.

Whatever the case, prioritizing sleep and addressing any underlying sleep issues may make AD less severe, she says.

Finding healthy ways to manage and avoid stress can help as well, because emotional stress can make atopic dermatitis worse in some people, says Wan.

The Takeaway

Atopic dermatitis is a chronic skin condition that causes itchy, dry, and inflamed skin. It's not contagious; rather, it's linked to genetic, environmental, and immune-related factors. Prescription treatments and self-care strategies can help manage atopic dermatitis.

Common Questions & Answers

What is the main cause of atopic dermatitis?
Atopic dermatitis is likely due to a combination of factors involving genetics, the immune system, and the environment. As a result, the skin barrier does not work as it should so that certain triggers can cause flare ups of dry, inflamed, itchy, rashy skin.
What does atopic dermatitis look like?
Atopic dermatitis can cause areas or patches of dry, scaly, inflamed skin that can have oozy bumps. For people of color a rash can appear dark brown, purple, or ash gray, while in white people it can look red or pink. The appearance and severity of AD can vary significantly from person to person.
How do I get rid of atopic dermatitis?
Some people may find that atopic dermatitis disappears on its own, but for others it can be a life-long condition. While there is no cure, there are numerous strategies to prevent flares, such as moisturizing skin, avoiding known triggers (such as certain foods or hot showers), and taking medication.

Resources We Trust

Editorial Sources and Fact-Checking

Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.

Sources

  1. Atopic Dermatitis. Cleveland Clinic. October 17, 2022.
  2. What Is Eczema? National Eczema Association.
  3. Atopic Dermatitis (Eczema). Mayo Clinic. May 15, 2024.
  4. Atopic Dermatitis. National Institute of Arthritis and Musculoskeletal and Skin Diseases. November 2022.
  5. FLF Gene. MedlinePlus. October 1, 2017.
  6. Maintz L et al. From Skin Barrier Dysfunction to Systemic Impact of Atopic Dermatitis: Implications for a Precision Approach in Dermocosmetics and Medicine. Journal of Personalized Medicine. June 2022.
  7. Reynolds M et al. Atopic Dermatitis: A Review of Current Diagnostic Criteria and a Proposed Update to Management. Journal of Drugs in Dermatology. March 1, 2020.
  8. Diagnosing Eczema and Dermatitis. NYU Langone Health.
  9. Brunner PM et al. Racial Differences in Atopic Dermatitis. Annals of Allergy, Asthma & Immunology. May 2019.
  10. Prescription Topicals. National Eczema Association.
  11. Yang H et al. Application of Topical Phosphodiesterase 4 Inhibitors in Mild to Moderate Atopic Dermatitis:?A Systematic Review and Meta-Analysis. JAMA Dermatology. March 27, 2019.
  12. Topical Calcineurin Inhibitors Factsheet. National Eczema Society. November 2023.
  13. Chovatiya R et al. JAK Inhibitors in the Treatment of Atopic Dermatitis. Journal of Allergy and Clinical Immunology. October 2021.
  14. Atopic Dermatitis (Eczema). Mayo Clinic. May 15, 2024.
  15. Prescription Injectables. National Eczema Association.
  16. Prescription Oral. National Eczema Association.
  17. Prescription Phototherapy. National Eczema Association.
  18. Eczema and Bathing. National Eczema Association.
  19. Wet Wrap Therapy. National Eczema Association.
  20. Skin Pigmentation and Eczema. National Eczema Society.
  21. Eczema. Johns Hopkins Medicine.
  22. Atopic Dermatitis: Understand Your Triggers. Mayo Clinic. March 8, 2023.
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Susan Bard, MD

Reviewer

Susan Bard, MD, is a clinical instructor in the department of dermatology at Weill Cornell Medicine?and an adjunct clinical instructor in the department of dermatology at Mount Sinai in New York City. Her professional interests include Mohs micrographic surgery, cosmetic and laser procedures, and immunodermatology.

She is a?procedural dermatologist with the American Board of Dermatology and a fellow of the American College of Mohs Surgery.

Dr. Bard has written numerous book chapters and articles for many prominent peer-reviewed journals, and authored the textbook?The Laser Treatment of Vascular Lesions.

Becky Upham

Author

Becky Upham began her freelance writing career covering live music shows in Asheville, North Carolina, but health and wellness have been part of her professional life for almost 20 years. She's been a race director, a recruiter for Team in Training for the Leukemia & Lymphoma Society, a salesperson for a major pharmaceutical company, a blogger for Moogfest, a communications manager for Mission Health, a fitness instructor, and a health coach.

She majored in English at the University of North Carolina and has a master's in English writing from Hollins University.

Upham enjoys teaching cycling classes, running, reading fiction, and making playlists.

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